The BASIS provides a forum for the free exchange of information related to addiction, and public access to the latest scientific developments and resources in the field. Our aim is to strengthen worldwide understanding of addiction and minimize its harmful effects. The Division on Addiction, Cambridge Health Alliance, a Harvard Medical School teaching hospital.

Wednesday, October 17, 2012

ASHES, Vol. 8(9) – Should you smoke that cigarette? The efficacy of question-based warning labels

In a previous issue of ASHES, we reported that graphical
cigarette warning labels had little effect on smoking behavior. Recently, the
D.C. District court of appeals upheld an earlier decision striking down these
graphic warning labels (R.J. Reynolds
Tobacco Co. v. FDA, No. 11-5332 (D.C. Cir. Aug. 24, 2012)). One major
factor for the decision was the FDA’s inability to prove the efficacy of the
graphical warning labels. In light of this decision, this week ASHES reviews a
study investigating whether altering the style of warning messages improves
their ability to alter smoking beliefs (Glock, Müller, & Ritter, 2012).

Glock et. al. postulate that defensive responses of smokers
against confrontational text and graphical warning labels might mean that they will
be less likely to change their smoking behaviors following exposure to such
labels. They propose that by rewriting warning labels as questions, or omitting
them altogether, smokers will create their own warning messages internally and
feel less threatened by the message.

Methods

Researchers recruited 60 students from Saarland University
who were daily smokers.

The researchers divided the cohort into 4 equal groups
and presented each group with one of four types of images on different sets of
15 cigarette packages.

Each cigarette package set included one specific
type of warning label: standard textual warning labels; graphic warning labels;
textual warning labels reworked into questions; or no warning labels at all.

Participants completed a questionnaire assessing
their smoking habits prior to and after viewing the cigarette packages.

Participants rated their perceived risk for six
smoking-related diseases on a scale from 0 (no risk) to 9 (highest risk).

The researchers conducted an a priori contrast
comparing the question and control groups with the graphic and textual groups.

Results

The researchers found that there was a
significant difference between the Question/Control and Textual/Graphical
warning label group, such that the Question/Control group reported higher
perceived risk. (Figure 1) (F(1,55) = 4.32, p=0.04, np2=0.07)

There was no significant difference between the
textual and graphical warning label (t(28) = 0.61, d = 0.22, p = .54) or
between the question warning label and control group (t(27) = 0.73, d = 0.27, p
= .47).

The small sample size limits the power of the
study. (n=15 for each group)

The cohort consists solely of college students,
which limits the generalizability of the results.

Young smokers have not smoked as many years as
older adults and might not be as worried about health consequences as they seem
less relevant in the short term.

This population intrinsically has a higher level
of education than young adults who have not attended college and might already
be more informed about the risks of smoking.

The novelty of a new warning label effect might
be the cause of the difference in risk perception as current smokers might be
accustomed to the present warning labels.

However, the authors note that the graphic
warning label had yet to be introduced in Germany where the experiment took
place.

Smoker risk-perception does not necessarily
result in a change in smoking behavior.

Discussion

Graphic warning labels have been scrutinized since their
introduction and it is unclear how effective they are as tools for smoking
cessation (Borland, Wilson, Fong et al., 2009; McCool, Webb, Cameron et al.,
2012). Glock et al. show that smokers presented with graphical and textual
warning labels have a lower smoking risk-perception compared with smokers in
both the control group and question label group. Furthermore, they argue that
although question type labels result in the same level of risk-perception as
the control condition (and higher than textual/graphical), a warning label of
some sort is still necessary to inform smokers. Additional research is required
to determine the effectiveness of question based warning labels and from there
we will be able to determine if they prove to be a viable alternative.

-Jed Jeng

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provide feedback on this article.

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